Cholestasis is a medical condition in which bile can’t flow from the gallbladder into the small intestine. There are a couple of different causes for this sort of problem, but the “cholestasis” label applies to them all; in general it’s used to describe an outcome, namely blocked bile, rather than the actual cause. Physical obstructions are one of the easiest to understand. When there are masses, tumors, or other growths in the liver or small intestine, bile passage can get choked up and it can begin to pool. There are also a number of chemical reasons why bile passage doesn’t happen as it should, including genetic defects and serious hormonal shifts. Pregnant women are often particularly at risk for the latter. In most cases symptoms are the same no matter the cause, and include darkening of the urine, yellowing of the eyes and skin, and intense itching, particularly on the hands and feet. The condition is almost always readily treatable, but prompt medical attention is usually really important to avoid serious health consequences.
Role of Bile Generally
Bile is an important part of human digestion. It’s a thick, sticky substance made by the liver, and its main job is to help the small intestine break down complex fats that are taken in through food. Breaking them down not only makes them easier to digest, but also easier to quickly convert into energy. In most cases the liver makes bile in advance, which it stores in the gallbladder. When the digestive system needs it, it flows into the small intestine and begins work — at which point the liver typically begins generating more.
Cholestasis happens when the passage from gallbladder to intestine is hindered somehow, which leads to a backup and overflow. The obstruction is likely to cause an abnormal build-up of lipids and bile salts in the blood stream, since they cannot be removed from the body. Its possible complications include weakening of the bones, diarrhea, and organ failure.
Physical Obstructions
When the condition is labeled “intrahepatic” it means that there is an obstruction in the flow of bile that occurs within the liver. This is often the most common form, and is characterized by medical conditions like hepatitis or by extensive obstruction of the small ducts. An extrahepatic condition, on the other hand, is a blockage outside the liver. These can occur as a complication of surgery, because of an infection that destroys tissues, or as a result of a serious injury. It can also be caused by tumors or stones in the bile duct.
Genetic and Hormonal Problems
People can sometimes also experience bile backups as a result of chemical imbalances in the body that cause the bile ducts to shrink, narrow, or collapse. These sorts of problems are often a result of a genetic abnormality or congenital liver problem. Liver disease often includes bile blockage and duct collapse as symptoms, for instance. Sometimes hormonal shifts can be causes as well, though in these cases the problem is often more temporary; as soon as the hormones stabilize, the problem tends to go away. In situations of genetic abnormality the issue tends to be more or less permanent.
Special Concerns in Pregnancy
Pregnancy heightens the sensitivity of the bile ducts to estrogen, which may cause a special type of condition known as “cholestasis of pregnancy.” It most commonly develops during the second or third semester of the pregnancy, and often causes intense itching. Treatment usually involves regular fetal monitoring and the use of topical anti-itch medication. A woman may also acquire the disease while using birth control pills with high hormonal concentrations. In most cases things will normalize once hormone levels return to normal, either because of birth or a cessation of the pills.
Diagnosis and Treatment
Diagnosis usually begins with an evaluation of a patient’s outward symptoms. From there, medical professionals and care providers usually order blood tests and diagnostic imaging such as computed tomography (CT) scans, magnetic resonance imaging (MRI), or ultrasounds of the abdomen to confirm whether or not the bile is flowing properly.
Treatment typically depends on the cause. Infections are usually treated with antibiotics, whereas stones, tumors, or other growths are more likely to be addressed through surgery or other more invasive procedures. Stents are sometimes also inserted in the narrowed or blocked portion of the bile duct to restore the flow of bile.
It’s usually the case that this condition can be prevented. Vaccinations for hepatitis A and hepatitis B are usually a good place to start, especially for people who are at risk of having the disease. Hepatitis isn’t always linked to bile problems, but the two are often related. Limiting the use of alcohol and harsh medications is also usually recommended, as both can damage the liver over time.